Those simple daily tasks that were once trivial in terms of their required effort, like a trip to the supermarket, can now send you into utter fatigue if you happen suffer from long COVID-19. This can be deeply frustrating, and you wonder how to manage your life when your batteries are constantly low.
Not all "fatigue" is the same, notes Dr. Carmen Scheibenbogen, head of the Charite Fatigue Centre at Charite University Hospital in Berlin. Most of her work deals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a condition marked by crippling fatigue that’s not improved by rest and is often accompanied by muscle aches.
"Even mild everyday exertion can lastingly aggravate the fatigue as well as the pain," she says. "If you try to carry on with your normal daily workload, it can gradually get worse and worse."
This phenomenon is known as post-exertional malaise (PEM), and some long COVID sufferers – "long haulers," as they’re sometimes called – have it. But fatigue typically isn't the only symptom of long COVID.
"Shortness of breath, muscle aches and heart palpitations can also worsen if you overwork yourself," says Dr. Martina Lukas, chief physician in the Department of Internal Medicine II at DKD Helios Hospital in Wiesbaden, Germany.
Getting some exercise often helps to reduce "normal" fatigue, but it can cause a severe breakdown in PEM patients, rendering them incapable of any activity for a while, says Scheibenbogen
So the worst thing to do is to grit your teeth and try to carry on as though you weren't fatigued. It's better to pace yourself.
"Pacing yourself means conserving your (energy) resources and recognizing your limits," explains Lukas, who is also active in her hospital’s long COVID outpatient department. Although it won’t eliminate your symptoms, it will improve the quality of your life by helping you to better manage your everyday tasks.
Everyone’s pacing strategy is different, but it always requires gauging how much energy you have. "Imagine that every day you’ve got a sack of ‘energy balls’ at your disposal," Lukas says. "Each activity costs one energy ball: Unloading the dishwasher, walking the dog, preparing lunch."
Physical activities such as work or doing household chores aren’t the only things that use up energy though. Even watching television or reading can be overly strenuous – mentally – Scheibenbogen points out. So you’ve got to take cognitive activities into account as well.
If you make sure to have some energy left in your sack at the end of the day, you’ve got a good chance of avoiding a breakdown.
Determining your optimal workload and learning not to exceed it can take a while. It can help to keep a journal that documents all of your activities – a half-day at the office, a trip to the post office, a phone call with your doctor.
"And if you’re not doing well on a particular day, you can check your journal and see what the reason might be," Lukas says.
Since your energy is limited, it’s essential that you set priorities. Just as you save the remaining battery power of your smartphone for an important call, so too should you look at the day ahead of you and decide what you definitely must do, and what not.
You can lighten your load by adjusting the demands you place on yourself – for example, settling on canned soup for lunch instead of making a freshly cooked meal because it saves energy that you could better use for something else.
It’s also advisable to space out your tasks. If you’re planning to take a walk, it might not be the best day to hoover your flat. And you don’t always have to stubbornly proceed according to plan.
On the other hand, making no demands of yourself isn't the right thing to do either. "It’s important to stay active," Scheibenbogen says, but only within the confines of what your energy level permits.
And if your pacing strategy is working well, you can cautiously increase your workload – slowly and in small steps. Exert yourself, but don’t overdo it.
